Single-anastomosis duodenoileal bypass with sleeve gastrectomy/SADI-S/SIPS

Heres what it boils down to:  Do you feel confident that eating less is all you need to lose all of the weight?  If that's been your problem all along, then the sleeve may be all you need.  For me, it took me 18 mos to lose a measly 21 lbs, so my body fought against me tooth and nail.

For many of us, though, we can champion eating less - it's our bodies that laugh  at any effort.  That's where the rerouting comes in.  It actually changes how your body metabolizes that food/fat/calories to give you the sustained success.  Malabsorption does not automatically lead to malnutrition.  It leads to one paying attention to their nutritional health. 

Great point! You are correct, overeating is only a small intermittent part of my weight issue.

I had the appt with my Dr. today and have settled on the decision to have the malabsorptive component. I will need to take bariatric multi vitamin with iron, A, D, E, K, Calcium, Iron, B12, and a B Complex after the surgery...for life.

Do you find the supplementation easy to manage? Are you able to take them once in the morning and be done or do you have to set reminders and take them all day?

I've always taken vitamins, so I don't imagine it will be a burden, but I'm not sure if it's different when you have to do it to avoid medical complications! 

Good point, Valerie, about paying attention to our nutritional health to avoid malnutrition.  We have to take ownership of taking the right vitamins and following up with regular lab draws.

VanDal, I am just a beginner with this vitamin process, but I spread mine out throughout the day for optimum absorption.  I am still on all chewables, so i just work them into my meal plan, dividing the calcium up into 3 doses and the iron separated from any calcium supplements or calcium rich foods.  Dr Enochs is giving the SIPS patients a bottle of a new Bariatric Advantage multi vitamin product that is about as close to an all in one that you could get.  Personally, I could not tolerate it - the smell or the taste, but that's just me.  I developed a pretty big post-op GAG response to some smells and tastes associated with protein drinks, broth, and sugar free jello.  That particular vitamin smells and tastes like protein to me.

As for your other questions, no, I have not had a moment's regret for having this procedure.  I had experienced a significant increase in my a1C over the past year and was on Metformin and Victoza injections.  I have been off both of those meds since the day of surgery with normal blood sugars.  That alone has been a very positive outcome for me!  KP

Thank you! That sounds manageable. I travel extensively with work, so I will have to investigate some travel solutions for dividing up doses.

Excellent news on your blood sugar!

You are correct about the vitamins and minerals.  There are some that can be taken once daily and others should be spread out throughout the day.  I would consult a nutritionist who understands the complex needs of bariatric patients (ie Patrick at Dr. Enochs' office) to get recommendations.  Your blood work will also dictate what you need to take and how much/when to take it.  

Additionally, it is your responsibility to make sure you get the proper blood work and other testing to ensure you stay healthy.  DO NOT ever depend on a Dr. to make sure you get the right tests.  Learn what tests to ask for and when to ask for them.  Bariatric surgeons generally know what tests you need, but primary care doctors do not always know exactly how to manage bariatric patients.  My mother had RNY five or six years ago.  Recently, she has had trouble with her hip, leg, and foot.  To make a long story short, she has been diagnosed with multiple stress fractures and a bone density test revealed that she has osteoporosis.  This is the first bone density test she has ever had.  I'm not a doctor, but even I know that in addition to having his/her blood monitored for calcium levels every six months, a bariatric patient needs to have regular bone density scans to make sure that the calcium level in the blood is not coming from the leaching of calcium from the bones.  You would think a medical doctor would know that, but apparently not. 

Great point! I wonder if there is a comprehensive list of recommended test/procedures for DS patients, with a timeline? I would assume we would follow a similar schedule.

Hey - I actually asked my primary to do a bone scan so that I would have a starting or pre-surgery starting point so I could tell if I was doing better or worse. Also, there is a lady they call Vitalady (vitalady.com) who is a bariatric patient and has been very very helpful to patients. One thing is making sure that we take DRY vitamins....so make sure the chews and "gel" caps are not fat soluable as we won't absorb them as well. A lot of the vet patients recommend also not just taking a ADEK multi vitamin but rather taking them separate A, D, E, K....as needed. Calcium needs to be spread out throughout the day.

To just try and have somethings on hand I purchased an AM\PM weekly pill dispenser for bedside and then just a weekly daily for my purse. I'll top off every Sunday night and hoping for the most part I can get away with 3x a day regimen.

Awesome advice and resources. I'll check those out.

I have an appt. with my primary care provider this Thursday. I'll have to ask about the base-line bone scan.

It's a habit like everything else.   You don't need a bariatric vitamin. 

1. A double-dose of a centrum (or generic equivalent) will do. 
2. The calcium needs to be Calcium Citrate (very important - absorbs best). 
3. You can get most over the counter except the fat solubles (ADEK), which you get in very high doses in dry formulation (locally they are dispensed in an oil cap that we will malabsorb most of).   Start on 50,000 iu post-op of the dry D3 and 25,000 iu of the dry A, the two most people are deficient on.  You will not find these locally, but can get them each through Amazon or Vitalady.com.  The dispensing company is BioTech.  Again, don't fall for the designer bariatric vitamins for ADEK combinations, either.  They do not contain enough of what we need, and it's much more cost-effective to take those seperately.

Thank you! I will start doing some research on what I can find locally and what I will have to find online.

This is such a well spring of great information. I hope the nutritionist post-op will have the same knowledge. It would be disappointing if he/she does not!